The Use of Intraoperative Ultrasound During Breast Conserving Surgery

• Published in: Clinical breast cancer Vol. 23; no. 1; pp. 54 - 59
• Main Authors: Fosko, Nicole K, Gribkova, Yelizaveta, Krupa, Kelly, BS, Kavita Jain, Moore, Dirk, Chen, Chunxia, Potdevin, Lindsay, Kumar, Shicha, Eladoumikdachi, Firas, Kowzun, Maria J
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2023
• Subjects: Breast - pathology; Breast cancer; Breast conserving surgery; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - drug therapy; Breast Neoplasms - surgery; Female; Humans; Localization methods; Mastectomy, Segmental - methods; Oncoplastic surgery; Retrospective Studies; Ultrasonography, Mammary - methods; Breast conserving surgery; Localization methods; Breast cancer; Oncoplastic surgery
• ISSN: 1526-8209; 1938-0666
• DOI: 10.1016/j.clbc.2022.10.003

The purpose of this study is to evaluate the utilization of intraoperative ultrasound (IOUS) for tumor localization in breast-conserving surgery and to examine its impact on margin positivity and re-excision rates. Additionally, the study seeks to identify factors contributing to surgeon utilization of IOUS.
A retrospective chart review was conducted of patients with preoperative diagnosis of breast cancer undergoing breast-conserving surgery by breast surgeons at multiple centers within a single healthcare system. Characteristics such as lesion size, palpability, histology, receptor status, and use of neoadjuvant chemotherapy were recorded. Re-excision rates were determined based on localization technique and surgeons’ status of breast ultrasound certification.
A total of 671 cases were performed, with 322 meeting study inclusion. 57 cases utilized IOUS, 250 utilized preoperative wire-guided localization (WGL), 10 used both methods and 5 cases used neither method. There was no significant difference in re-excision rates between IOUS and WGL or among the four surgeons. Ultrasound-certified surgeons were more likely to utilize IOUS, and re-excision rates trended higher for WGL, which may be clinically significant.
Increasing familiarity with and utilization of IOUS during breast-conserving surgery may be clinically advantageous over traditional localization techniques. Ultrasound certification may lead to increased use of IOUS among surgeons.
This is a retrospective study examining the use of intraoperative ultrasound (IOUS) in breast conserving surgery and the impact of IOUS on margin positivity and re-excision rates and factors contributing to breast surgeon utilization of IOUS. Conducted in patients with preoperative diagnosis of breast cancer undergoing breast-conserving surgery by breast surgeons at multiple centers within a single healthcare system. There was no significant difference in re-excision rates between IOUS and WGL or among the 4 surgeons. Ultrasound-certified surgeons were more likely to utilize IOUS, and re-excision rates trended higher for WGL.